The U.S. experienced a swine flu threat in 1976. Fearing that the virus was a direct descendant of the 1918 deadly flu epidemic, the government wanted everyone to get vaccinated. Fortunately, the epidemic never broke out and the threat never materialized.
Unfortunately, cases of a rare side effect thought to be linked to the shot did materialize. Within ten weeks, the unexpected development had ended an unprecedented national vaccination campaign.
The 1976 episode embarrassed the federal government thus costing the director of the then U.S. Center of Disease Control his job. Worst of all it has triggered an enduring public backlash against flu vaccination, which may be fueling some anxiety about the current outbreak.
The swine flu debacle holds crucial lessons for the government and health officials who must decide how to react to the new swine flu threat in the days and weeks ahead.
For starters, officials must keep the public informed. They must admit what they know and don’t know. They must have a plan ready should the health threat become dangerous. And they must reassure everyone that there is no need to worry in the meantime.
It’s a tall order. Doubts about the government’s ability to handle a possible flu pandemic linger, said Dr. Richard P. Wenzel, chairman of internal medicine at Virginia Commonwealth University, who diagnosed some of the early cases in 1976.
“I think we’re going to have to be cautious,” Wenzel said. “Hopefully, there will be a lot of good, honest public health discussion about what happened in 1976.”
Officials should be prepared for plenty of second-guessing, especially for any decisions regarding vaccination, which was at the core of the 1976 controversy, said Dr. David J. Sencer, the CDC director who led the government’s response to the threat and was later fired.
“There were good things and bad things about it,” said Sencer, who is retired and lives in the Atlanta area. “People have to make science the priority. They have to rely on science rather than politics.”
The question of whether politics overtook science in 1976 has been the fodder of books, articles and discussions for 33 years.
The panic in 1976 was partly because of the erronoeous belief erroneous that the 1918-19 flu pandemic, which killed half a million Americans and as many as 50 million worldwide, was caused by a virus with swine components. Recent research suggests instead that it was avian flu, but that seems unlikely to assuage the current anxiety.
The episode began in New Jersey in February 1976, when an Army recruit at Ft. Dix, fell ill and died from a swine flu virus thought to be similar to the 1918 strain. Several other soldiers at the Ft. Dix base also became ill. Shortly thereafter, Wenzel and his colleagues reported two cases of the flu strain in Virginia.
“That raised the concern that the original cluster at Ft. Dix had spread beyond New Jersey,” said Wenzel, former president of the International Society for Infectious Diseases.
At the the Centers for Disease Control and Prevention (“CDC”), Sencer solicited the opinions of infectious disease specialists nationwide and, in March, called on President Ford and Congress to begin a mass inoculation.
The $137-million program began in early October, but within days reports emerged that the vaccine appeared to increase the risk for Guillain-Barre syndrome, a rare and possibly fatal neurological condition that causes temporary paralysisl.
Waiting in long lines at schools and clinics, more than 40 million Americans — almost 25% of the population — received the swine flu vaccine before the program was halted in December after 10 weeks.
More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine; 25 died. No one completely understands the causes of Guillain-Barre, but the condition can develop after a bout with infection or following surgery or vaccination. The federal government paid millions in damages to people or their families.
However, the pandemic, which some experts estimated at the time could infect 50 million to 60 million Americans, never unfolded. Only about 200 cases of swine flu and one death were ultimately reported in the U.S., the CDC said.
The public viewed the entire episode as a political farce, Sencer said. But at the time, he said, the government erred on the side of caution.
“If we had that knowledge then, we might have done things differently,” Sencer said. “We did not know what sort of virus we were dealing with in those days. No one knew we would have Guillain-Barre syndrome. The flu vaccine had been used for many years without that happening.”
Wenzel also recommended vaccination in 1976. “It was a great effort,” he said. “It just had unexpected, unfortunate side effects.”
In Mexico, where 22 people have died from the current swine flu outbreak, government officials are under fire for their handling of the situation. But people fail to understand the challenges faced by health officials with such a mysterious threat, said Dr. Peter Katona, an infectious disease expert at UCLA.
“You have to look at not only 1976 but 1918,” he said. “The pandemic flu that occurred in 1918 lasted a year and a half. In 1976, we didn’t know what was going to happen. The virus might burn out. It might proliferate. These viruses have a mind of their own, and we don’t know how to predict what will happen.”
CDC officials have been wisely circumspect in their comments about the current outbreak, Sencer said.
“I like the fact that they have said, ‘We may change our minds,’ ” he said. “Don’t expect health officials to have the answers overnight. These things need time to be sorted out. We’re still in the learning curve.”
Dr. Richard Krause, who headed the National Institute of Allergy and Infectious Diseases in 1976, has noted drolly that public health officials involved in the next pandemic flu threat “have my best wishes.”
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